NEW Case study of Young TB (#14)
RF lateral BEFORE trim you can see the high heels and long lateral walls causing a steep "clubby" foot. VERY steep toe angle of 60 degrees! This causes a poor attachment for the coffin bone. This would have been the foot that recurrent lameness would have occurred.
RF Before (#14 )
RF After (#14)
The heels and bars were very long causing the long lateral walls to flare excessively. After trimming, the toe angle is close to 45 degrees and the hairline is close to 30 degrees.
RF sole Before trim (#14)
Here you can see the widely stretched white line and long bars.
RF sole after trim (#14)
Trimming the walls, bars and heels to conform to the coffin bone makes a neater healthier foot.
Left Foot lateral view Before trim (#14)
The left foot has long bars and heels too but this foot is more under-run and less "clubby" than the RF. I find this is very typical that one foot is more contracted with a higher heel while the other is flatter. You can see the quarter crack in this wall forming all the way to the coronet.
LF lateral view After
What pushes the lateral wall out? Long under-run heels and long bars! With the vertical rasping on the lateral walls, I will look for the tubule growth to realign itself in the proper direction. When the tubules are aligned, there will be no crack in the wall.
Case Studies
Case #1 Before
This young draft horse was being trimmed regularly by a trimmer who did not understand that long bars can cause the horse to put too much weight on his toes. In this photo, you can see that the lateral cartilages are pushed up out of the hoof capsule by the bars.
After
Still needing some additional heel lowering, this is much improved. What can be seen in this photo is that the damage done to the toe laminar wall is still in the process of healing. But the angle of the toe wall has much improved and the lateral cartilages have dropped back down into the hoof capsule.
#2 Before trim Under-run TB
This young horse is standing with it's front legs behind the vertical and his hinds in front of the vertical. It indicates heel pain in the front feet and as the hinds try to take some of the weight off the front end, the toes get long in the hind feet.
After trim Under-run TB
This is after the first trim. Now the legs are straight!.
2 years later Under-run TB
The horse has grown and matured quite a bit and he is a lovely sweet horse.
Under-run heels in TB with weak horn
This is a lateral view of the left front before I began trimming. The horse had lice and poor quality hair coat along with under-run heels with over-grown bars. Even with this lateral view, you can see that the heel point is way forward and the lateral hairline is arched as the heel folds under the horse. Also the convex toe wall profile would indicate that the coffin bone is tipped forward by the under-run heel. This puts pressure on the circumflex artery in the toe, reducing circulation to the sole in the toe callous area.
Under-run heels Before 1st trim
The above Left Front before trimming shows a folded under heel with bars that are curved in an S. Heel quarters are flared out and white line in the lateral walls are stretched. Sole is of poor quality. One thing that I would say positive about his feet is they're not very contracted and with the coffin bone tipped forward and all that bar under the foot, i don't think he was feeling any pain. This is due to lack of blood flow from excess horn.
Under-run heel work in progress
This is a case of "sometimes it looks worse before it looks better". A famous veterinarian did some research and came to the conclusion that "bar grows sole". This doesn't make sense because bar horn is like your fingernails and sole horn is like your skin of your fingers. But in the case of this horse and in some other horses I have trimmed, the pathology of under-run heels causes the bar to grow over top of the sole. Then sometimes the sole and bar horn mix so you could see how a researcher taking a microscopic section of "sole" in this area could come to the conclusion that bar grows sole. Since this horse grows such poor quality sole compared to the area of sole/bar mixing, it is tempting to believe in Bowker's findings. But I think the ultimate goal is to get the sole corium working again to produce good sole. Since the toe laminar corium was damaged as well (by long-term under-run heels), getting a good connection growing down is also a problem. with this horse too, I believe this horse's problem is genetic. He has fine hair and thin skin. Hoof horn is nothing more than modified hair and skin.
The improvements that can be seen in this photo compared the one above is that the bars are straighter. But the sole and white line horn is in really bad shape.
The improvements that can be seen in this photo compared the one above is that the bars are straighter. But the sole and white line horn is in really bad shape.
'Starting to get some bruising but getting better
I hesitate to put this photo in as it does show the in between stage when the hoof is doing a significant amount of "house-cleaning" with abscessing dead material out. This is a recent photo and you can see the abscess exits in both the toe callous area (no callous!) and the white line. Unfortunately it also shows a lot of bruising where I had let excess bar/sole mix grow out over the sole. All it did was bruise the horn underneath! So much for that idea! But let's talk about the positive things I see. The foot is a nicer rounder shape and the wall horn is a consistant thickness (not really thick at all but consistantly thin is more like it!) with a tight white line, if you excuse the tip where that nasty abscess was. This foot had so much weight shifted forward onto the circumflex artery and sole corium that there must still be a lot of dead stuff in there working its way out. It really is a work in progress to get blood flowing back into areas that had been cut off.
Close up of abscess in toe sole and laminar wall
Actually, the one in the sole has finally healed. The black stuff in the white line is the "pit of despair" but its finally going to go with my aggressive treament of soaking in ACV water. (hehehe aggressive, yeah right!) I talked to a friend who used to be a farrier (now a equine dentist) and he said he would just cut all the dead stuff off and let it start over! I did resection the wall in the earlier photos you can see. And I dug just a bit here to open the white line up a bit more. What I think it is is that the coffin bone sat on the circumflex artery for so long that it killed off much of the coffin bone front edge and that dead stuff is still working its way out.
LF bulb view after 1st trim
This bulb is about as thin as I've ever seen. The bulb, the digital cushion and frog is very important to shock absorbtion in that if it is healthy, it works like an expansion joint. In this case, it's like the expansion joint is stretched out. I have to try to ressurect it.
Under-run heels in TB After consistant corrective trims
Although much improved, this horse still lacks toe height and sole growth in the toe callous area. But note the improved heel and hairline. Things that were addressed were liver detoxification and supportive nutritional supplements. As I continue to back up the toes and trim excess bar, foot should continue to improve. The horse is sound in boots or grass but cannot tollerate rocky ground due to thin sole and poor toe height.
Many people falsely believe that "all TBs need shoes". I believe this comes from the fact that some TBs do indeed have thin skin and fine haircoats which translates into weak hoof horn. Just like some people have hard fingernails and some people have soft thin fingernails. I do believe it is in part genetic but I also believe that the horn can be strengthened through good nutritional support and detoxing the liver. Shoes however, would not improve the horn quality. It would just confirm what everybody thinks about TB feet. I feel like I'm almost there with his feet. Maybe about 8 more weeks.
Many people falsely believe that "all TBs need shoes". I believe this comes from the fact that some TBs do indeed have thin skin and fine haircoats which translates into weak hoof horn. Just like some people have hard fingernails and some people have soft thin fingernails. I do believe it is in part genetic but I also believe that the horn can be strengthened through good nutritional support and detoxing the liver. Shoes however, would not improve the horn quality. It would just confirm what everybody thinks about TB feet. I feel like I'm almost there with his feet. Maybe about 8 more weeks.
Much later
I'm still growing that frigging crack out, stubborn thing! My fault though for not soaking in vinegar water enough. But he has a significant amount of concavity that he didn't before and though he still lacks toe height, I think its coming. The sole is very pitted but I believe this too will grow healthy as I am able to balance the foot and grow a healthy laminar connection. I can dream, can't I? It's tricky though, gotta back up the toe, yet leave the toe quarters for the concavity. The real trick is to get that heel to pull back and straighten up those heels and bars. They keep wanting to fold under.
Frontal view of LF March of 2010
Toe cracks are maddening! As you can see down in the front toe quarter the last of the toe crack. It has caused me much time and effort in this wet winter. But I've got it down to just a small abscess in the sole of the toe and laminar wall. I'm still not happy about his soundness and toe height and although he does have a very small amount of concavity, his sole is still pitted and unhealthy. But his wall horn is a lot better.
The under-lying reason for one flat foot and one more contracted foot is habit!
This horse has a habit of putting his left front foot forward and right front foot back when he grazes or in this case, gets some grain off the ground. His feet actually have improved in some ways but this habit is impossible to break so he will keep recreating the problem of an under-run heel on the left front. Another thing I found out later is his teeth were in really bad shape. He was loosing weight so I had his teeth floated by the equine dentist.
Actually a little concavity!
When I compare this photo to my old ones, it shows measurable concavity. Not much but I don't think I'm going to get much.
#3 Puncture wound healed with natural healing
This shows a puncture wound to the sole (see directly below the tip of the frog) The horse was severely and immediately lame after stepping on a sharp hidden piece of glass or metal. Puncture wounds are not uncommon in both shod and barefoot horses. The difference is, in a shod horse, this kind of injury would be life-threatening as I learned from a horse I had many years ago. That horse got the best medical treatment money could buy and still the final treatment of euthanasia was done. If I knew then what I know now I could have saved that horse's life! I would have also saved myself thousands of dollars.
The treatment route I took with this horse was to trim the sole to allow the wound to heal from the inside out. I trimmed the hoof for maximum blood flow and kept the wound clean by soaking in a mild solution of apple cider vinegar and water. The wound took only a few weeks to heel to the point that the horse was sound again.
The treatment route I took with this horse was to trim the sole to allow the wound to heal from the inside out. I trimmed the hoof for maximum blood flow and kept the wound clean by soaking in a mild solution of apple cider vinegar and water. The wound took only a few weeks to heel to the point that the horse was sound again.
A few days later
Kept nice and clean in a soak of ACV water, this puncture could be seen clearly after 10 days. You might be interested to read what the reality is with hoof wounds and veterinary understanding....
("proximal to the foot" means above the hoof)
This is from the 1999 AAEP proceedings, Andrew H. Parks, MA, Vet MB writes in his paper, Equine Foot Wounds: General Principles of Healing and Treatment:
“Most equine clinicians are familiar with the healing and treatment of traumatic wounds to the distal limb, proximal to the foot, because the general principles of wound healing are well taught in veterinary schools. This receives constant reinforcement as these wounds are a weekly if not daily occurrence in general practice. Foot wounds, although less frequently encountered, are not uncommon. Unfortunately, they are often treated hesitantly by practioners, presumably because of misunderstanding or unfamiliarity, so that the treatment is ineffective. This is probably because (1) little time is spent relating the principles of healing to the treatment of foot wounds in already overcrowded college curricula, (2) the morphologic differences between the integument of the foot and skin is confusing, and (3) experience with management of such wounds in practice is less common. Unfortunately, there is little or no information from research on the way foot wounds heal, so that practical treatment of foot wounds must be based on experience and extrapolation from research on skin wounds.”
In other words, the difference between the sole horn and the skin is too "confusing". They also don't know how to treat foot wounds because they don't get enough experience and they are only taught how to heal wounds above (proximal to) the foot. And they are not taught the principles of healing foot wounds due to overcrowded curricula. I think this is unacceptable! But it stems from the basic and erroneous practice of leaving the care of the feet to the farrier who applies shoes and maybe got a high school degree, maybe not. Also he may or may not have gone to a 6 week farrier school! I met a recent farrier school graduate at a lecture I was giving. He told me he didn't learn anything about the feet other than how to nail a shoe on it!
And the confusion continues when even recently, there are veterinary researchers trying to tell us that "bar corium grows sole horn". This is the equivalent of saying, "your fingernails grow the skin on you fingers".
("proximal to the foot" means above the hoof)
This is from the 1999 AAEP proceedings, Andrew H. Parks, MA, Vet MB writes in his paper, Equine Foot Wounds: General Principles of Healing and Treatment:
“Most equine clinicians are familiar with the healing and treatment of traumatic wounds to the distal limb, proximal to the foot, because the general principles of wound healing are well taught in veterinary schools. This receives constant reinforcement as these wounds are a weekly if not daily occurrence in general practice. Foot wounds, although less frequently encountered, are not uncommon. Unfortunately, they are often treated hesitantly by practioners, presumably because of misunderstanding or unfamiliarity, so that the treatment is ineffective. This is probably because (1) little time is spent relating the principles of healing to the treatment of foot wounds in already overcrowded college curricula, (2) the morphologic differences between the integument of the foot and skin is confusing, and (3) experience with management of such wounds in practice is less common. Unfortunately, there is little or no information from research on the way foot wounds heal, so that practical treatment of foot wounds must be based on experience and extrapolation from research on skin wounds.”
In other words, the difference between the sole horn and the skin is too "confusing". They also don't know how to treat foot wounds because they don't get enough experience and they are only taught how to heal wounds above (proximal to) the foot. And they are not taught the principles of healing foot wounds due to overcrowded curricula. I think this is unacceptable! But it stems from the basic and erroneous practice of leaving the care of the feet to the farrier who applies shoes and maybe got a high school degree, maybe not. Also he may or may not have gone to a 6 week farrier school! I met a recent farrier school graduate at a lecture I was giving. He told me he didn't learn anything about the feet other than how to nail a shoe on it!
And the confusion continues when even recently, there are veterinary researchers trying to tell us that "bar corium grows sole horn". This is the equivalent of saying, "your fingernails grow the skin on you fingers".
Puncture wound in the process of healing
As the wound healed, it grew toward the toe. I used only ACV water, scrubbed the wound with soap and water, and used propolis and Tea tree oil in the wound itself. I used NO Betadine or any kind of caustic (chemical burning) or pain killers. I did have the foot x-rayed to determine that there was no metal in the wound but mainly to document the extent of the wound which went all the way to the coffin bone.
Rehab walking two puncture wound healing horses
This is me riding Dewees, my mare, while ponying Patrick on a rubber running track. His case is one I wrote about too in The Horse's Hoof magazine. I may put his case study on this web site later. So even though the first few weeks I couldn't ride in the hunt field, this kind of riding was done every day. She actually was fitter going back to hunting than she was prior to the start of the season.
Puncture wound completely healed
The wound is shown here completely filled in with new sole tissue. I have found that any kind of leg wound, even severe, heals faster and without accompanying proud flesh, just by keeping the wound clean and keeping the hoof flexible for maximum blood flow by trimming and soaking.
The lesson I learned from this is that hoof boots are a very good investment, that "ounce of prevention", and although a barefoot horse is healthier, no horse, shod or barefoot, domestic or wild, is immune to a puncture to the hoof.
The main difference with a shod horse is that sometimes there is alot more dead horn built up on the hoof and the contraction forces an un-natural vaulting of the sole. I wild horse has a lot more dense horn than can be created in the environment of a soft pasture like I have.
A barefoot horse, when treated holistically, will likely heal completely, while a shod horse will most likely have to be euthanized, even with the best veterinary care because there is just no time in vet school to teach students how to heal a puncture wound to the foot.(see above from AAEP proceedings.)
The lesson I learned from this is that hoof boots are a very good investment, that "ounce of prevention", and although a barefoot horse is healthier, no horse, shod or barefoot, domestic or wild, is immune to a puncture to the hoof.
The main difference with a shod horse is that sometimes there is alot more dead horn built up on the hoof and the contraction forces an un-natural vaulting of the sole. I wild horse has a lot more dense horn than can be created in the environment of a soft pasture like I have.
A barefoot horse, when treated holistically, will likely heal completely, while a shod horse will most likely have to be euthanized, even with the best veterinary care because there is just no time in vet school to teach students how to heal a puncture wound to the foot.(see above from AAEP proceedings.)
Back in the Hunt Field!
Taken by Rich Wientraub, our MFH
I have to admit, she healed alot faster than I expected. The puncture wound was all the way to the bone. This photo was taken by a fellow rider while out fox hunting about two months after the puncture wound occured.
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#4 Barefoot Draft cross (you can't just leave them barefoot!)
This horse had way over-grown walls, heels and bars which cause separation and stretched lamina..Pretty wonky huh?
After one year
While this horse still lacks a little more concavity and toe height than I would like, he moves beautifully and scores in the 70s in dressage. His feet have very healthy, hard horn.
#5 Hoof Wall Cracks
Coronary contraction and a contracted coffin bone (oval not parabolic) led to these cracks.
Crack on x-ray
8 months later, one persistant crack could be seen on x-ray but it had not gotten all the way to the corium. Cracks are often deep and you can't tell from the outside how deep they go. See the photo below of this same foot at that time to see how the crack appeared on the hoof. If i were trimming this same hoof today. I would resect the wall around the crack so that it could be exposed to air.
Cracks still barely there but wall has much better attachment
These cracks were mainly superficial but I have been battling them ever since this horse was 3 years old! That's when I started into learning how to trim at a Nancy Filbert clinic in SC that I wrote about in the Barefoot Stories book. The original reason why I went to that clinic was the fact that this horse had cracks in his walls. This is a photo 2 years after the one above that shows the cracks at their worse. The trick in this hoof is to get all of the tubules to line up to the same direction. That and keeping the coffin bone balanced within the hoof. See the below 2008 X-ray showing this same hoof and compare it to the x-ray above taken in 2006. This horse grew and was not fully mature physically until he was 9 years old.
No sign of cracks!!! And note better alignment of the bones.
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#6 Sheared Heel and contraction
Although the owner of this horse had been trimming him, progress decontracting was slow. I took him for a few months and with rehab walking on a rubber track and trimming every few days, he made good progress in decontraction and I was able to fix his sheared heel.
Shear improved but hoof still contracted
"Butt crack" is indication of severe contraction but heel shear is much improved..
Decontracting in progress
Although this photo is not straight, you can see that the butt crack has started to open up and abscessing is occuring in the frog. Really look at the black coloration below the skin of the bulbs. That necrotic tissue extends deeply into the digital cushion (remember the frost bitten fingers?) All of this dead material takes time for the body to abscess out. Bruising of the sole and various parts of the hoof horn are bound to happen as the hoof capsule stretches. It gets ugly before it gets pretty!
Starting to open and straighten
The "butt crack" is starting to open. Abscessing in the frog was inevitable as contraction had caused much necrosis (death) of frog tissue and the digital cushion. It takes a long time to get this kind of hoof to come back from the pathology that was present. The key to getting this foot opened up was lots of soaking, walking on rubber paved track, and frequent trimming of bar and displaced heels. Due to the shear and contraction beyond-the-vertical on the outside heel of this foot, the palmar process fractured. He was only a little lame on it, but the owner was working with a trainer who was working with a well-respected vet. BTW, Fractured palmar processes are very common in shod horses too! In a shod horse, the fracture heals to a deformed shape. In a barefoot horse, the rehabilitation itself causes the process to fracture, but it repairs itself into a healthier shape. A fracture can heal faster in a foot with good blood flow! (Why this simple fact escapes the the imagination of one of the top veterinarians in my state, I do not know! His recommendation was to shoe the horse!)
#7 Shod 4 yr. old quarter horse Before shoe removal
Horse stands with front feet forward due to pain in front feet. This is commonly referred to as a "founder stance" but anytime there is pain in the front feet, the horse will have a tendency to relieve weight on the fronts by shifting weight to the hinds. The hinds in this photo show no harmonic curve of the pastern and the hips are tilted down while the cannon bone is positioned at an angle to the ground (not perpendicular as a healthy alignment would be)
After shoe removal and first conservative trim
Although the change in conformation is subtle due to my conservative first trim, you can see a slightly better alignment in the joints and the weight distribution. What I will look for in the next trim will be a lowered head and more relaxed hindquarters that are not tucked under with perpendicular cannon bones on all four legs and a harmonic joint alignment in the pastern.
7 weeks second trim
Note changes in head and neck carriage was well as alignment in hip and shoulder.
Transition from shoes LF
This 4 yr old quarter horse (body shown above) had been shod on the fronts for about 6 weeks (owner guesses) but I suspect this horse was shod for a lot longer than that indicated by the "founder" rings on the wall. Both front feet show signs of damage to the laminar connection in the flattened toe wall.
LF After 1st trim
I did a conservative 1st trim on this horse. She has contraction issues but the hoof looks relatively healthy considering it has been shod. I am looking forward to seeing a much improved hoof by March or April of 2010.
7 week trim
Much better trim angles. Hoof has a ring which indicates inflammation when shoes were removed. Inward toe crack goes all the way to coronet as expected when horse has had high heels for even just a few years.
LF Transition Sole View Before
As you can see, the hoof had grown beyond the shoe.
LF Transition Sole view After
I took the wall down all around and backed up the toe. I trimmed the bars very conservatively and the tip of the frog.
7 week trim
Trimmed heels and bars down considerably more.
RF Transition from shoes
I Look for this horse to have some abscesses from the damage these shoes have done.
RF Transition After trim
Again I look to lower these heels some more on the next trim. Owner will have some soaking boots by then. This RF has quite a bit more "dish" in the front. After the owner begins soaking and walking, I will lower the heels more and try and get a better attachment growing.
7 week Trim
Much better angles with this trim. Again inflammation ring shows just below the hairline demarking when shoes were removed. This foot has less coffin bone attachment than the LF but both were compromised by shoes and upright angles.
RF Oblique Before
You can see in this oblique view that the hoof has really high heels.
RF oblique view After
I will be taking this heel down some more.
RF at 7 week trim
Heels and bars trimmed to proper height
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Abscessing in a foundered horse
This horse was being trimmed by it's owner. The horse is 25+ mare, and the owner is 65+ woman. The horse has an laminitic episode 2 months prior to what is seen here. Owner called me because she couldn't figure out what was going on. It's really simple. The horse had a huge blister in the hoof. The sole is just like your finger skin and the wall is just like your fingernail. The difference is we don't walk on our fingers and the horse has evolved to walk on his. An abscess is like a blister or pimple. It can be huge like this one and encompass the whole foot or it can be tiny and inconsequential.
Understand Abscessing in a transitioning hoof
This shows a whole sole, frog and bar abscess. Sometimes just small abscesses occur but sometimes major ones like this. What you need to understand is this a part of the healing process, not to be disrupted with medication or veterinary digging!!! Your horse will be very, VERY lame when he is developing an abscess like this. You may think he's broken his leg. What you should do is soak his foot and walk him or turn him out with other horses that will move him. The worst thing you can do is put the horse in a stall and leave the foot hot and dry. And CALL ME. The reason why we don't want to give the horse pain killers as most of them are anti-inflammatories and the body is working hard to make this abscess come out. Anti-inflammatories slow the process down and you do not want to do that!
Why do the feet make abscesses when transitioning or healing? Well think of those frost bitten fingers and then imagine that all that pus and dead tissue is inside a tight place. It creates pressure and produces enzymes that dissolve tissue in an effort to be expelled. If you've ever had a blood blister under your fingernail, you will have a mild idea of what an abscess is like in a hoof. Usually abscessing in recovering feet come out at the bulbs, frog or sole but they can also work their way out at the coronet. Below shows an abscess that worked its way out to the coronet.
Why do the feet make abscesses when transitioning or healing? Well think of those frost bitten fingers and then imagine that all that pus and dead tissue is inside a tight place. It creates pressure and produces enzymes that dissolve tissue in an effort to be expelled. If you've ever had a blood blister under your fingernail, you will have a mild idea of what an abscess is like in a hoof. Usually abscessing in recovering feet come out at the bulbs, frog or sole but they can also work their way out at the coronet. Below shows an abscess that worked its way out to the coronet.
Abscess coming out the coronet
Another abscess working out of the coronet band
This owner was sure her horse had injuried himself. But I pointed out to her the fact that she was leaving his lateral (outside) wall almost an inch longer than the medial (inside) wall. Because the lateral wall was so long,. it bent in and put pressure on the corium, which, damaged, then abscessed. The exudiate was yellow and red pus. This photo was taken after I helped her with the trim.
Solar abscess owner trimmed
After trimming the above foot, the true extent of abscess is revealed
There was so much excess horn on this foot but the owner wanted to trim it herself and I hadn't heard from her in over a year. By the time the owner called me, she had spent lots of money with the vet and did a lot of extra work, putting her horse through a lot of pain. The treatment the vet prescribed actually exacerbated the situation and prolonged the healing.
Abscessing in the toe callous area can mean coffin bone protrusion
When there is abscessing in the toe callous area, it is from the coffin bone pressure on the sole. This combined with separation of the laminar toe wall was due to long under-run heels in this foot and was actually caused by the high heel contracted clubby opposite foot. The horse was weighting this foot more because of the continous pain in the opposite foot. When she lost suspension, her coffin bone actually dropped down inside the hoof capsule and because it was tipped forward by those high bars, it came through the sole at the toe. See case study #12 below.
Before shoes were removed
Toeing out seems to be a common quarter horse conformational problem. A healthy bone alignment should be straight or slightly pigeon-toed. Though some of this toeing out may correct itself as the horse develops width in it's chest and his hooves are trimmed to allow for proper balance.
Before removal of shoes LF lateral view with medial view of RF
See the four nails on the outside and the blacked wall horn indicating necrotic tissue.
Even shod horses get abscesses
This is a medial view of the right front of the horse above after the shoe was pulled showing the large old abscess exit that has grown down. It will take about another 4 months for this to grow completely out. What causes abscessing like this is pressure on the corium!
RF sole view before shoe removal
Compare this quarter horse foot to the other case study above and see contraction issues here are a bit worse in this one. Note the 4 nails on one side and only 3 on the other side.
How to have an x-ray done
When you have an x-ray done of your horse's feet (which I highly recommend!) be sure to tape a wire to the hairline and a horseshoe nail or wire to the front toe wall. You can tape a penny or put a shallow thumbtack at the tip of the frog too. Be sure to pick up the opposite foot so that the one x-rayed is fully weight-bearing and that the camera is perpendicular to the lateral wall. These landmarks will help the trimmer determine several things. First, the position of the coffin bone inside the hoof capsule. If you look at my founder cases, you will see how the toe wall diverges from the coffin bone. The wire will show how high up within the hoof capsule the coffin bone is positioned. The extensor process should be level with the wire which indicates the hairline. If the coffin bone were tipped forward, the heels would need more trimming. If the toe wall diverged, the toe may need backing up. If the coffin bone has dropped within the hoof capsule as it does in a founder case, but still ground parallel, the bars would need to be trimmed down and the horse would need to wear hoof boots with pads. Ideally, the hairline whould measure at an angle of 30 degrees and the toe/coronet angle should measure approximately 100 degrees (95 for hinds and 105 for fronts is the absolute ideal but I feel 100 degrees for the front is acceptable. What you DON'T want is a toe/coronet angle that is greater than 105 degrees. That would indicate toe wall separation.) You also want to look at the dorsal profile of the coffin bone. either convexity or concavity means there is coffin bone loss. The profile should be straight.
Dissection of cooked foot showing internal structures
Cody's Left Front boiled out and separated from the short pastern at the coffin joint. What you can see here is the joint surface of the coffin bone and the navicular bone which would articulate with the distal end of the short pastern. The white tissue on either side is the remnants of the lateral cartilages. The caramel colored deep flexor tendon is in the middle. Darker areas are cooked venous plexus. On the right side of this photo you can see one of the deep digital arteries (the other side broke off deeper). The dark extensor tendon can be seen at the top of the hoof. After cooking, the different ligaments and tendons took on different shades of brown. The navicular ligament was very dark.
View of the cooked foot with the short pastern still intact
See the extensor tendon in the front and the Flexor tendon in the back.
Hoof capsule emptied
Here you can see the bottom of the coffin bone as a crescent above the shrunken sole coria and frog coria. The sole corium is a very important structure for both growing sole horn and is an important blood and nerve rich sensory organ. Just like the ends of your fingers are nerve-rich, so also is the horse's sole. A healthy corium is thick, even after boiling. An unhealthy corium would be thin and when cooked out, turns to mush. Even though this foot was from a severely foundered horse, it was as healthy as I could get it to be (the horse was sound) and the sole thickness was about 3/8" thick. The horse was sound and died of pulmonary embolism.
Cross section thru wall, sole, bar and frog
From left to right: wall, "white" line (really tan) sole, white line, bar and frog. This is the hoof from Cody, my pony. My mentor, Nancy Filbert, always told me that Cody's problem was bar horn. Well here we see that even though I had trimmed the bars to sole level, which is below the level of the wall horn, it was still pushed up into the hoof capsule and I would have had to have trimmed the bar 1 cm more to measure one cm from the collateral groove. This would include trimming below the level of the sole by at least a cm. It makes sense that if I had trimmed the bars back to 1 cm, the horse would have been more comfortable on his heels. This is probably the number 1 point I try to make to people experimenting with trims that advocate leaving the bars at sole height. Also, when I measured the heel, it was 4 cms. The heel height in a healthy foot should be trimmed to 3 cms according to Strasser so I missed the mark there too. Although in my defence, the horse was due for a trim so I would have trimmed those heels and bars! That's the beauty of keeping records is that you know when you should trim. Notes and photos are also very helpful in plotting progress but nothing beats getting your horse's feet after he dies to really know what was going on and if what you were doing worked. This horse was sound, dispite significant damage to the coffin bone and my small trimming mistakes.
#9 Progress made in joint adaptation/navicular case
Though I did not take Before photos (they would have shown high heels with soup can feet), this is the day after the first trim on this horse diagnosed with navicular. He was lame and has contraction issues on all four feet. Worse than that, is the straight pasterns. This photo is a close up and I wish I had taken it from farther away but even so, you can see that this horse has very straight pasterns. I had to be sure he was weighting his heels while also leaving enough toe that he wouldn't knuckle over. The owner is one of the best I work with. She has done a lot of stretching therapy and I believe it has really worked. The horse is almost 100% sound on grass at walk trot and canter. I trim him every 2 weeks. We've made this much progress in 4 months!! See the photo below for progress after 4 months.(it was taken before I did his most recent trim) The hoof is almost 45 degrees and the pastern joint is about 60 degrees. Considering he started out at about 85 degrees, this is real progress! He still has significant contraction and the white line separation that comes from de-contracting, but the owner reports that he is really doing well. Four months after his first trim he won 5th place out of a class of 10 (probably shod) horses at an open show!
Improved pastern angle (no longer straight up!
#10 Toe-in, contraction and heel shear in this draft Quarter horse
This horse has a diagnosed lameness grade one in the left front. I assessed his gait and stance and easily determined that his problems were a result of high heels, high bars and medial/lateral imbalances. The vet had looked for problems higher up in the fetlock as the horse has ringbone seen on x-ray. Ringbone is not the problem! It is the result of the problem! The obvious imbalances in the foot are the problem! The owner said the vet recommended corrective orthopedic shoes!. When the owner asked about barefoot trimming, the vet said she thought barefoot was a "fad". I am extremely dissapointed because I have used this same vet and thought she was "on board" with the barefoot paradigm of health. Vets are not interested in bringing your horse back to health. They will not make any money on a healthy horse!!
LF of the above horse showing medial/lateral imbalance, high heels and bars, and contraction
This horse was walking on his toes with very stiff gait. He was standing with his left front leg in a relief posture ("buck-kneed") See photo below.
If you look at the hairline in this photo you will see that the outer wall (on your right) is shorter than the inner wall. This is heel shear where one side of the heel is pushed up higher than the other. The horse puts more weight on the outside heel. This is usually a result of evading a painfully high bar on the inside. Since most bars are straighter on the inside they usually push up higher into the interior of the hoof causing pain and possible damage to the flexor tendon and navicular bursa. Since the flexor tendon, digital arteries and navicular bursa are all above the bars, they have the potential for damage if this condition is not remedied by a proper corrective trim and conscientious rehabilitation. With the high heels, the digital arteries, that join and become the transverse arch inside the coffin bone, are pinched shut. This causes the laminar corium in the front of the hoof to become deprived of blood. The pressure on the laminar horn at this angle also causes damage, which results in a loss of suspension. As circulation returns in the next few weeks, the laminar corium that was damaged will experience inflammation and abscessing as the hoof "house cleans". A new attachment must grow in to re-suspend the coffin bone. Also, the frog corium is cut off from blood supply.
So what has to happen with this foot? First the owners are educated to understand the importance of hoof health to the over-all health of the horse. Then they are educated about what a healthy hoof should look like and what is necessary for rehabilitation. I provided this education in a 3 hour group briefing lecture program which included a slide show, models and dissections. I then trimmed the horse on Sat. The owner will begin a soaking regime to allow the hoof to become more flexible and allow it to re-shape itself into a less contracted state. During this time, the horse will be walked on straight lines, on level, firm, non-concussive ground to help the lamina grow back into a healthy state. The horse will be in the company of a herd to move him around and will receive a diet that includes magnesium, calcium and flax seed as well as trace minerals. He will likely experience some abscessing and pain but he will also have days where the owner will think she is riding a horse who's energy and enthusiasm for movement is unsurpassed! Oh and the owner will have me trim the horse on a regular basis to help reverse contraction as quickly as possible.
If you look at the hairline in this photo you will see that the outer wall (on your right) is shorter than the inner wall. This is heel shear where one side of the heel is pushed up higher than the other. The horse puts more weight on the outside heel. This is usually a result of evading a painfully high bar on the inside. Since most bars are straighter on the inside they usually push up higher into the interior of the hoof causing pain and possible damage to the flexor tendon and navicular bursa. Since the flexor tendon, digital arteries and navicular bursa are all above the bars, they have the potential for damage if this condition is not remedied by a proper corrective trim and conscientious rehabilitation. With the high heels, the digital arteries, that join and become the transverse arch inside the coffin bone, are pinched shut. This causes the laminar corium in the front of the hoof to become deprived of blood. The pressure on the laminar horn at this angle also causes damage, which results in a loss of suspension. As circulation returns in the next few weeks, the laminar corium that was damaged will experience inflammation and abscessing as the hoof "house cleans". A new attachment must grow in to re-suspend the coffin bone. Also, the frog corium is cut off from blood supply.
So what has to happen with this foot? First the owners are educated to understand the importance of hoof health to the over-all health of the horse. Then they are educated about what a healthy hoof should look like and what is necessary for rehabilitation. I provided this education in a 3 hour group briefing lecture program which included a slide show, models and dissections. I then trimmed the horse on Sat. The owner will begin a soaking regime to allow the hoof to become more flexible and allow it to re-shape itself into a less contracted state. During this time, the horse will be walked on straight lines, on level, firm, non-concussive ground to help the lamina grow back into a healthy state. The horse will be in the company of a herd to move him around and will receive a diet that includes magnesium, calcium and flax seed as well as trace minerals. He will likely experience some abscessing and pain but he will also have days where the owner will think she is riding a horse who's energy and enthusiasm for movement is unsurpassed! Oh and the owner will have me trim the horse on a regular basis to help reverse contraction as quickly as possible.
Note relief posture (knee slightly bent to relieve heel pain) in left front before trim.
Bulb view of LF after trim
This is a bulb view of the left front after trimming so from your view, the outside lateral wall is on your right. To correct the heel shear in the foot, I trimmed the inside lateral wall and heel slightly more. If you compare the lateral wall lengths you will see that they are very close to the same length. Note the darkened skin tissue below the central sulcus. That is indicative of necrotic tissue within the digital cushion. This will be abscessed out through the frog. I trimmed opening cuts (displaced heel), bar and lateral walls as well as smoothing the sole to the dirt line. The toe needed very little rasping as it had been worn down due to being frontally loaded.
LF Lateral Before trim
You can clearly see the very upright stance of the horse (62 degree toe angle) The point of impact of the heel is aligned directly below the navicular bone. No wonder this horse was landing toe first! The hairline angle is less than 20 degrees which indicates a coffin bone that is tipped forward. And since the owner provided me with a copy of her horse's x-rays of this foot, I could see that indeed that was the case.
LF after trim
After the trim you can see the better angles (48 degree toe angle and approx. 28 degree hairline) The horse ran around all night in a new environment which may have helped to open this contracted foot up. But due to the damage from high heels and bars, I suspect he will have some inflamation in the lamina. I always look at my after photos and wish I had taken more heel! This one I wish I had trimmed about 1/8" more heel to bring it closer to 30 degrees. Perhaps the owner can do a little rasping of the heel?
LF sole view Before trim
As you can see in this sole view, the outside wall (your left) is more flared than the inside wall. The outside bar has more pooling and more angle than the straighter inside bar. Since we know that the horse is pigeon-toed, we can assume it is caused by evading pain from this inside bar. The greater weight put on the outside half of the foot has caused more flaring of the wall there. This foot has significant contraction too. I lament the fact that to me this simple and obvious problem is completely unseen by the veterinarian and she then looks for problems higher up in the fetlock and pastern and recommends orthopedic shoes! Are veterinarians really "health" professionals or "sickness" professionals?
LF sole view After trim
After the trim you can see that I took the bars down, (although they could be taken down even more as they are very impacted), and trimmed the frog so you could see the darkened tissue below the surface. That is DEAD from the pinching of contraction and high bars! This is a white foot with what should be a white frog. Stay tuned to see the frog come back to life as the heels open up and let good nourishing blood into necrotic digital cushion tissue! There will be abscessing! And that's a good thing! Hoof house cleaning!
Frontal view of Left Front confirms that the inside (medial) wall is straighter and shorter
This is the LF before the trim. As you can see, a small but significant crack is beginning to form at the toe. This is from being frontally weighted. I trim to have a ground parallel coffin bone which distributes the weight evenly around the hoof wall and frog. This foot does have walls that diverge and that is what will help him to de-contract..
Case #11 Front foot of an Outer Banks pony with a good trim
This pony has excellant quality horn and he just needed a good trim to help him along!
Hind foot of the Outer Banks pony
This is as close as I've come to trimming a wild horse's foot. This guy has really hard horn but was suffering some of the same things our domestic horses suffer from which is high heels and bars. I have seen Outer Banks feral horses and the ones I saw had very under-run feet.
Case #12 TB with tendon bow LF
BEFORE trim
This 4 yr old TB mare off the track for a bowed tendon really had problems with her feet! A study was done on TBs with short heads and necks that stated that these horses would likely have a club foot. With this mare, it is very true. Her short head and neck predisposed her to develop a very contracted high-heeled foot on the right front from getting in the habit of always putting the left foot forward and the right one back. Consequently, she got a flat under-run foot on the left. With the stress of race training and shoeing, this difference in hoof shape caused a career-ending soft tissue injury, a bowed tendon... OR was it the foot???
Although the tendon seems serious, the problem is with the feet! In the BEFORE photo, you can see her stance with her front feet behind the vertical and hind feet ahead. Compare it to the AFTER one below which shows her afterwards with a relaxed stance, shoulders no longer bunched and tight and hips no longer tucked under, with straight legs after her trim.
Although the tendon seems serious, the problem is with the feet! In the BEFORE photo, you can see her stance with her front feet behind the vertical and hind feet ahead. Compare it to the AFTER one below which shows her afterwards with a relaxed stance, shoulders no longer bunched and tight and hips no longer tucked under, with straight legs after her trim.
AFTER 1st trim
The TRUTH about "bowed tendons"...
This Thanksgiving, before you cook your turkey, do a dissection of some turkey tendons in the leg. (by the way, tendons connect muscle to bone; ligaments connect bone to bone.)
"Bowed tendon" is considered a common injury in horses. However, it is very UNlikely that the tendon itself is injured. What is seen and called a "bowed tendon" is the fluid which the body sends into the tendon sheath to protect the tendon. The tendon is only very rarely damaged.
In this horse's case, the swelling in the leg was most likely due to the abscess in the left front foot. When you understand that the difference in the two feet would be like running around with a stilleto-heeled shoe on one foot and one of those flat Earth shoes on the other, its easy to see how damage could be done.
There is an old saying in veterinary medicine that I think most vets forget. That is: "Always suspect the foot!" In most cases, it is a foot problem that is causing lameness!
"Bowed tendon" is considered a common injury in horses. However, it is very UNlikely that the tendon itself is injured. What is seen and called a "bowed tendon" is the fluid which the body sends into the tendon sheath to protect the tendon. The tendon is only very rarely damaged.
In this horse's case, the swelling in the leg was most likely due to the abscess in the left front foot. When you understand that the difference in the two feet would be like running around with a stilleto-heeled shoe on one foot and one of those flat Earth shoes on the other, its easy to see how damage could be done.
There is an old saying in veterinary medicine that I think most vets forget. That is: "Always suspect the foot!" In most cases, it is a foot problem that is causing lameness!
LF loss of suspension, coffin bone protrusion abscess, under-run heels, long bars
Left front before trim
When I tell people that a horse would rather walk.on it's coffin bone coming thru the sole than weight the bars, this is an example! The bars are very long and due to the under-run heels which jack them up into the tender area under the navicular bone, The horse chooses to put it's weight on the toe. Eventually, with a loss of laminar connection, the coffin bone comes right thru the sole. In this case, the abscess at what should be the toe callous is what we see from the bottom. Look at the lateral view to see how the top half of the toe wall is convex from the coffin bone being tipped forward while the bottom half of the toe wall is stretched and separated. Due to the long bars and under-run heels, the lateral wall is separated from the inside of the foot structures.
Left front Lateral view BEFORE trim
LF sole after trim
LF after trim
I trimmed the bars, pulled the heels back and rasped the flared wall. With the horse more comfortable in it's heels, it will take the weight off the front half of the foot allowing the coffin bone to resuspend itself by growing in a new laminar attachment.
The lateral view of this foot below shows that I rasped the flared wall off and you can see old abscess exits from the weakened attachment. All the white area is the sub-layers of horn. This foot is very comparable to the under-run TB gelding I have. Note the hairline curve near the bulb of the heel where the under-run heel dragged it down.
The lateral view of this foot below shows that I rasped the flared wall off and you can see old abscess exits from the weakened attachment. All the white area is the sub-layers of horn. This foot is very comparable to the under-run TB gelding I have. Note the hairline curve near the bulb of the heel where the under-run heel dragged it down.
Left front lateral AFTER
After 4 1/2 weeks
The amount of horn growth is said to be normally about one forth inch every 4 weeks. But surprisingly, this wall grew an amazing 1/2 inch in a little over 4 weeks! This proves the fact that injured tissue grows faster than normal healthy tissue. The body tries to repair itself as quickly as possible. The abscess exit on the lateral wall makes it easy to measure wall growth.
Right front is the clubbed one
Same horse, two different feet; also called "high/low" one contracted and upright, the other one flat. Think about this, the contracted high-heeled one formed over time when the foal reached down for his grass and couldn't make it with that short head and neck, so he put one foot forward and one foot back and that became the habit. Through the early training when shoes were applied, the foot was kept in this deformed state. The left flatter foot received an unnatural amount of weight, It is the one that eventually failed and sustained injury. But if the feet had been trimmed to correct the imbalance when the foal was growing, this injury would probably never have happened. Compare this bulb view of the right more contracted foot with the left one below. Both are contracted but the right is worse.
Left front bulb view Before trim
Left Front bulb view After trim
Sorry about the flash as we were in the barn but you can still see how much I took the heels and bars down.
Right Front bulb view After trim
Comparing the Left front to the Right, you can see the contracted heel in the right. But look at the After photo below of the dorsal view and see how even these two very different hooves can look more alike after a good trim. There is still alot of healing to be done but by decontracting the more contracted foot and helping the left flatter foot to regain its health, this horse should be on its way to recovering.
RF sole view after trim
RF after trim
After being trimmed, this right front foot doesn't look so bad. I have a feeling that once the left front has better suspension and attachment and once this foot opens up, they won't look so different.
Compare RF to LF Before trimming
This is a very dramatic photo showing the difference in the two feet prior to the first corrective trim. You can clearly see that the right front is very much higher heeled than the left front which is under-run.
4 and 1/2 weeks after first trim
Since we know this horse was standing on her toe, we can assume there has been some coffin bone remodeling in this foot. It is more contracted and likely the tip has had some loss of bone due to pressure. But this photo shows a much better angle for the foot.
Dorsal view of fronts after 1st trim
Dorsal view of both fronts after 2nd trim
#13 Patrick's puncture wound
This is after the vet surgically removed a stick which had punctured the sole at the tip of the frog. The owner called me when she returned from hunting. She was riding out with a vet that told her the horse had a pulled suspensory ligament and needed stall rest. No one, not even the owner, picked up the foot and looked at it until I was called a couple of days later. The stick was the diameter of a dime and was deeply impaled into the sole. I told the owner to call a vet as I was unable to remove the wood from the horse's foot as long as he could feel what I was doing. The vet looked and set up an appointment in her hospital for the next morning. (poor horse!) She removed a significant amount of sole and we could see exactly how deep the wound was. It was to the bone. The vet wanted the owner to put the horse in a stall and keep the foot in a dry bandage with medications. The owner listened to me instead, and we used holistic healing of keeping the foot in a boot with ACV water changed every hour or so for the first few days. Then she brought the horse to me while she went out of town and I healed him along with my mare who also had a puncture wound. Interesting to note that this horse had very thick soles and bars which had been left thick for hunting. My mare had her normal good trim. I've seen photos of mustang hooves that had puncture wounds which healed and they just went right on. This one healed too.
3 months later
I believe this puncture wound took longer to heal because the wound went about 3 days before it was discovered and the splinter removed. Also I think the fact that the vet used caustic Betadine and may have removed healthy tissue along with the damaged tissue may not have helped. But it did heal eventually and the owner still fox hunts the horse. The prognosis by the vet when it first happened was that it would likely result in infection to the bone and the horse would need to be destroyed. That didn't happen!!! How would you like to go to the doctor with a splinter in your foot and have her tell you that you would likely never recover and would probably die?